PFNA-Ⅱ和Gamma3临床治疗股骨转子间骨折的疗效比较

Efficacy comparison of PFNA-Ⅱ and Gamma3 in the treatment of femoral intertrochanteric fractures

目的：回顾性探讨亚洲型股骨近端抗旋髓内钉（ proximal femoral nail anti-rotationⅡ，PFNA-Ⅱ）和第三代Gamma钉（ third generation of Gamma nail ，TGN）治疗股骨转子间骨折的临床效果。方法收集我院2009年1月～2012年12月收治的172例股骨转子间骨折患者，其中男性75例，女性97例；年龄35～82岁，平均（63.4±14.8）岁。随机分为两组，每组86例。对照组患者以TGN治疗，观察组患者以PFNA-Ⅱ治疗。治疗完成后，对两组手术临床指标、术后功能评分和并发症进行对比。结果 PFNA-Ⅱ组手术用时（59.4±19.7）min、透视次数（18.6±2.4）次、出血量（152.3±109.4） ml都显著性低于TGN组的（76.8±23.8）min、（22.4±2.7）次、（188.4±128.5）ml，P＜0.05； PFNA-Ⅱ组切口长度为（7.4±2.2）cm与TGN组的（6.7±2.4）cm差异无统计学意义（P＞0.05）；PFNA-Ⅱ组骨折愈合时间（11.8±2.6）周和髋关节功能评分（85.3±13.9）分与TGN组的（12.6±2.5）周、（83.7±15.4）分差异无统计学意义（ P＞0.05）；两组手术均未出现切割股骨头、内固定断裂、骨不连等并发症发生。结论相较于TGN手术，PFNA-Ⅱ的手术时间、透视次数及出血量明显减少，但术中并发症和术后功能评分没有明显优势。

Objective To investigate the efficacy of proximal femoral nail anti-rotation Ⅱ（ PFNA-Ⅱ） and the third-generation Gamma nail （ TGN） in the treatment of femoral intertrochanteric fractures .Methods Totally 172 cases of fracture in our hospital from Jan .2009 to Dec.2012 were selected and randomly divided into 2 groups, 86 cases in each group .Among these patients 75 were male and 97 were female ,ranged from 35 to 82 years with an average age of （63.4＋14.8） years.Patients in the control group were treated with TGN and those in the observa-tion group were treated with PFNA-Ⅱ.Surgical incisions , postoperative functional scores and complications were compared.Results The operation time,fluoroscopy times and blood loss were （59.4 ±19.7）min,（18.6 ±2.4） times and （152.3 ±109.4）ml,respectively,which were significantly lower than those of the control group [（76.8 ± 23.8） min,（22.4 ±2.7） times,（188.4 ±128.5） ml,P〈0.05];the incision length of PFNA-Ⅱ and TGN group was （7.4 ±2.2） cm and （6.7 ±2.4）cm,respectively,indicating no significant statistical difference （P〉0.05）;the fracture healing time and hip score of the PFNA-Ⅱgroup were （11.8 ±2.6） weeks and （85.3 ±13.9）,respective-ly,while those of the TGN group were（12.6 ±2.5） weeks and （83.7 ±15.4）,respectively, the difference was not statistically significant（P〉0.05）.Neither group developed surgical cutting of the femoral head ,fixation breakage, nonunion or other complications .Conclusion Compared to TGN ,the operation time , fluoroscopy times and blood loss of PFNA-Ⅱare significantly lower ,while there is no significant difference on intraoperative complications and postoperative functional scores .